Re: Severe PIH 34 weeks
From: Andrew Folley (agfolley@hotmail.com)
Thu May 24 15:54:07 2007
Thanks art interesting fact. Do your recall the cutoff for increased
risk???Also there is something about severe HTN and normal growth of infant
as to lowereing the infants risk of morbidity and mortality
13000 ladies studied. those with PIH and no IUGR had pernatal mortality of
8.4% . The PIH with IUGR had perinatal mortality of 29%.
>From: evsono@pipeline.com (art fougner, md)
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Re: Severe PIH 34 weeks
>Date: Thu, 24 May 2007 10:22:39 -0500
>
>Since Redman and Bonnar in 1976 demonstrated a relationship between risk
>of perinatal mortality and uric acid level, a uric acid of 4 mg % is
>reassuring as far as the perinate is concerned.
>
>Art
>
>At Thu, 24 May 2007, Andrew Folley wrote:
> >
> >Good point. Creatinine 0.5 uric acid 4 LFTs all normal
>platelets
> >300,000.
> >
> >>From: evsono@pipeline.com (art fougner, md)
> >>Reply-To: ob-gyn-l@obgyn.net
> >>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
> >>Subject: Re: Severe PIH 34 weeks
> >>Date: Thu, 24 May 2007 05:45:46 -0500
> >>
> >>Just curious - what is the blood uric acid level?
> >>
> >>Art
> >>
> >>At Wed, 23 May 2007, Andrew Folley wrote:
> >> >
> >> >Have to respectfully disagree with you in spite of your gray hair. I
>am
> >>not
> >> >aware that PIH is the same animal as preeclampsia and is treated the
> >>same.
> >> >We still have to "practice" medicine and work within the guidelines of
> >> >medical knowledge and not do a knee jerk reaction and say "get her
> >> >delivered" to every problem making it an NICU problem and not an OB
> >>problem.
> >> >Agreed BP 170/110 is a medical emergency and needs to be treated
>quickly.
> >> >Treatment does not necessarily warrant delivery. Show me the
>literature
> >>to
> >> >support delivery. I still have not seen a reason why the baby at 33w
>5d
> >>is
> >> >better off in the NICU than in the mother. Moms BP is controlled with
> >> >labetalol and procardia at this time.
> >> >
> >> >>From: "R. Daniel Braun" <rd.braun@gmail.com>
> >> >>Reply-To: ob-gyn-l@obgyn.net
> >> >>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
> >> >>Subject: Re: Severe PIH 34 weeks
> >> >>Date: Wed, 23 May 2007 14:53:38 -0500
> >> >>
> >> >>You got enough Gray hair on this list telling you to deliver that you
> >>don't
> >> >>need to worry about all that other stuff.
> >> >>Myself, Joe C, Joe P, Art, Bob, et al.
> >> >>
> >> >>BTW BP 110 diastolic is a medical emergency in any patient, pregnant
>or
> >> >>not,
> >> >>PIH or not, Toxemia or not, Essential Hypertension or not. It needs
>to
> >>be
> >> >>lowered right away to prevent blowing out a vessel in the Squash. PIH
>is
> >> >>just a variant of toxemia and should be treated the same. IMHO.
> >> >>
> >> >>Dan
> >> >>
> >> >>On 5/23/07, DoctorJoe@aol.com <DoctorJoe@aol.com> wrote:
> >> >>>
> >> >>> In a message dated 5/23/2007 1:08:17 P.M. Central Daylight Time,
> >> >>>AllanHo@aol.com writes:
> >> >>>
> >> >>>The flip side of this argument is that if you deliver the baby, say
>by
> >> >>>c/s, and the mother died from a PE. Now the burden of proof would
>be
> >>on
> >> >>>why
> >> >>>the baby had to be delivered so urgently... Because you "think"
> >>something
> >> >>>bad is going to happen?
> >> >>>
> >> >>> No, you document what you did and why you did what you did.
> >> >>>
> >> >>>In this case, a "well grown" baby implies, at least to me, the
> >> >>>hypertension is due to preeclampsia. The treatment is delivery. We
> >>don't
> >> >>>"think" the treatment is delivery -- it is obstetric dogma that the
> >> >>>treatment is delivery.
> >> >>>
> >> >>>If, for the sake of argument, we posit that the HBP is due to
>chronic
> >> >>>hypertension, then that carries a WORSE prognosis as far as
>abruption
> >>and
> >> >>>sudden fetal death, since there is chronic small vessel disease,
>yada,
> >> >>>yada,
> >> >>>yada. (It doesn't look like that here, since there is no IUGR,
>oligo,
> >> >>>etc.,
> >> >>>but for the sake of argument ... .) So we don't "think" she needs
>to
> >>be
> >> >>>delivered, we know that the stats on severe hypertensives in
>pregnancy
> >>are
> >> >>>bad and there is a higher chance of something bad happening from the
> >>HBP
> >> >>>than, say, a PE postoperatively.
> >> >>>
> >> >>>All of that goes on the chart, is discussed with the patient, and
>you
> >>do a
> >> >>>C/S. If you do it NOW, you'll likely have less maternal morbidity
>than
> >>if
> >> >>>you let her "declare" herself.
> >> >>>
> >> >>>Joe P.
> >> >>>
> >> >>> ------------------------------
> >> >>>See what's free at AOL.com
> >> >>> ------------------------------
> >> >>> ------------------------------
> >> >>> ------------------------------
> >> >>> ------------------------------
> >> >>> ------------------------------
> >> >>> ------------------------------
> >> >>><http://www.aol.com/?ncid=AOLAOF00020000000503>.
> >> >>> ------------------------------
> >> >>>
> >> >>> ------------------------------
> >> >>> ------------------------------
> >> >>--
> >> >>> ------------------------------
> >> >>R. Daniel Braun, MD FACOG(L) CMT
> >> >>> ------------------------------
> >> >>Professor Emeritus
> >> >>> ------------------------------
> >> >>Dept. of Obstetrics and Gynecology
> >> >>Indiana U. School of Medicine
> >> >>
> >> >>R. Daniel Braun
> >> >>
> >> >> "The way to health is an aromatic bath and scented massage
> >> >>everyday".
> >> >> Hippocrates
> >>
> >>--
> >>art fougner, md
> >>"May The Wings of Liberty Never Lose a Feather." - Jack Burton
> >
> >_________________________________________________________________
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> >
>
>--
>art fougner, md
>"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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